Healthcare Provider Details

I. General information

NPI: 1487930988
Provider Name (Legal Business Name): VAUGHN TSOUTSOURIS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E EARLL DR STE 420
PHOENIX AZ
85012-2649
US

IV. Provider business mailing address

8550 CUTHILLS CIRCLE
LINCOLN NE
68526-9467
US

V. Phone/Fax

Practice location:
  • Phone: 602-499-6695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4502
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: